Category X Drugs Absolute Contraindication In Pregnancy

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A. Thalidomide is an antinausea drug that was at one time prescribed for pregnant women for "morning sickness." (It is no longer used.) This drug can cause fetal limb reduction (e.g., meromelia, amelia), ear and nasal abnormalities, cardiac defects, lung defects, pyloric or duodenal stenosis, and gastrointestinal atresia.

B. Aminopterin and methotrexate are folic acid antagonists used in cancer chemotherapy. If used during pregnancy, these drugs can result in small stature, abnormal cranial ossification, ocular hypertelorism, low-set ears, cleft palate, and myelomeningoceles.

C. Busulfan (Myleran), chlorambucil (Leukeran), and cyclophosphamide (Cytoxan) are alkylating agents used in cancer chemotherapy. Consumption during pregnancy may cause fetal cleft palate, eye defects, hydronephrosis, renal agenesis, absence of toes, and growth retardation.

D. Phenytoin (Dilantin) is an antiepileptic drug.

1. In 30% of cases, consumption of phenytoin during pregnancy results in fetal hy-dantoin syndrome, which includes growth retardation, mental retardation, microcephaly, craniofacial defects, and nail and digit hypoplasia.

2. In the majority of cases, consumption during pregnancy results in fetal cleft lip, cleft palate, and congenital heart defects.

E. Triazolam (Halcion) and estazolam (ProSom) are hypnotic drugs. Consumption during pregnancy, especially in the first trimester, results in fetal cleft lip and cleft palate.

F. Warfarin (Coumadin) is an anticoagulant dnig that acts by inhibiting vitamin K-de-pendent coagulation factors. Use during pregnancy can cause stippled epiphyses, mental retardation, microcephaly, seizures, fetal hemorrhage, and optic atrophy in the fetus.

G. Isotretinoin (Accutane) is a retinoic acid derivative that is used to treat severe acne. Use during pregnancy can cause fetal CNS abnormalities, external ear abnormalities, eye abnormalities, facial dysmorphia, and cleft palate (i.e., vitamin A embryopathy).

H. Clomiphene (Clomid) is a nonsteroidal ovulatory stimulant that is used in women with ovulatory dysfunction. Although no causative evidence of a deleterious effect of clomiphene on the human fetus has been established, there have been reports of birth anomalies.

I. Diethylstilbestrol is a synthetic estrogen that was used to prevent spontaneous abortion in women. Many women who were exposed to DES in utero have reproductive system disorders including cervical hood, T-shaped uterus, hypoplastic uterus, ovulatory disorders, infertility, premature labor, and cervical incompetence. These women are also subject to increased risk of adenocarcinoma of the vagina later in life.

J. Ethisterone, norethisterone, and megestrol (Megace) are synthetic progesterone derivatives. Consumption during pregnancy results in masculinization of genitalia in female embryos, hypospadias in males, and cardiovascular anomalies.

K. Ovcon, Levlen, and Norinyl are oral contraceptives that contain a combination of estrogen (e.g., ethinyl estradiol or mestranol) and progesterone (e.g., norethindrone or levonorgestrel) derivatives. Consumption of these drugs during pregnancy results in an increase of fetal abnormalities, particularly the VACTERL syndrome, which consists of vertebral, anal, cardiac, tracheoesophageal, renal, and limb malformations.

L. Nicotine is a poisonous, additive alkaloid delivered to the fetus through cigarette smoking by pregnant women. (Cigarette smoke also contains hydrogen cyanide and carbon monoxide.) Smoking during pregnancy can cause intrauterine growth retardation, premature delivery, low birth weight, fetal hypoxia due to reduced uterine blood flow, and diminished capacity of the blood to transport oxygen to fetal tissue.

M. Alcohol is an organic compound delivered to the fetus through recreational drinking or addictive drinking (i.e., alcoholism) by pregnant women. Consumption of alcohol during pregnancy can cause fetal alcohol syndrome, which includes mental retardation, microcephaly, holoprosencephaly, limb deformities, craniofacial abnormalities (i.e., hypertelorism, long philtrum, and short palpebral fissures), and cardiovascular defects (i.e., ventricular septal defects). Fetal alcohol syndrome is the leading cause of mental retardation.

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